Trying to Determine the Real Health Risks of Steroids

Steroids are dangerous drugs that will leave you in an early grave, at least according to sensational media reports. Your doctor will probably tell you something similar.

However, there are experts who make a reasonable-sounding argument that careful use of steroids carries minimal risk.

So who should we believe, and why is there even a question?

Anabolic Steroids

Steroids in this sense are the hormone testosterone and variations of it, AKA anabolic steroids (the term “steroid” actually encompasses more).

In the last century it was found that taking supraphysiological amounts—meaning more than the body produces naturally—enhances performance, increasing aerobic capacity, strength, and muscle mass.

Steroids and Modern Physical Culture

Steroids are routinely used in sports at all levels, but their most common use is for cosmetic purposes, specifically muscle growth.

And it’s not surprising, steroids enable more physical development than what you’d otherwise be capable of, and at a much faster rate. This makes them very tempting for anyone seeking to improve their appearance.

Muscle and… Early Death?

Testosterone is a fundamental hormone with wide-ranging effects in the body, which means that supplementation of it (and its analogs, ie, what we refer to generally as anabolic steroids) is a blunt instrument with many potential actions apart from intended alterations to muscle mass.

It’s quite a list. You might be okay with exchanging testicular atrophy and baldness for extra muscle, but sudden cardiac death is a different thing altogether. Destroying health for appearance benefits isn’t an appealing prospect for most people, but are steroids really that bad?

The Obscured Relationship Between Steroids and Health

Establishing the safety profile of steroids is problematic, and the long-term effects of physique-enhancing doses are hard to pin down. There are multiple reasons for this.

Legal Barriers to Science

Steroids are illegal in many countries, which hampers scientific study. Our legal systems aren’t very sympathetic to the idea of testing high doses of illicit drugs to see how huge a person can make their muscles for the purpose of looking more like a superhero.

Observational Studies

Okay, you might think, let’s just look at a whole bunch of steroid users and see how they’re doing. The problem is that there’s really no meaningful uniform group of behaviors that the term “steroid user” sums up. This means it’s impossible to definitively home in on exactly what is causing what.

A few of the troublesome variables:

Dose – there’s no one-size-fits-all physique enhancing dose to look at. Based on my participation in bodybuilding circles, a 500 mg weekly steroid dose is on the conservative end for muscle building. That’s roughly 10 times what the male body naturally produces in testosterone.

But doses of up to 50 times the amount of natural hormone are commonly self-reported, and even more in some cases. That’s a big difference, and you’d expect very different side effects between those protocols.

Drug specificity – just as vague as the term “steroid user” is the term “steroids” itself. There are many types, all of which have varying effects and degrees of risk. Even the form they’re taken has implications for side effects—for instance, oral steroids tend to be damaging to the liver while injections are not (in pills the drug has to be modified to survive digestion, and this has a hepatotoxic effect).

Further, it’s common for any particular drug to be taken by itself, but also to stack different types together for cumulative benefit.

Source – another issue is that much of what people take is sourced from a black market. Substances are made in underground labs with no guarantee of sterility, potency, or even that the product contains what is printed on the label. This means any effects seen could be due to these other factors outside of what you’d expect from the specific drug alone.

The Picture Gets Murkier

Physique development has evolved considerably over the years, and people have become bigger and leaner than ever. Some of this is due to the progression of training and nutrition science, but also larger doses of steroids, less time off them (to the point of never coming off), and the addition of totally different classes of substances including insulin, growth hormone, and fat loss drugs.

There is also an ever-expanding grey market of experimental pharmaceuticals.

As if establishing the risk of steroids by themselves wasn’t problematic enough, the polypharmacy aspect is a major confound and makes the cause-and-effect chain of health outcomes very complex.

Relax, No One Ever Died of Steroids!

You’ll often hear that steroids are some of the safest drugs there are. On an acute level, that’s true, even compared to things we normally consider quite benign like aspirin. People do die after ingesting over-the-counter drugs, while we never hear about deaths directly attributable to steroid overdose.

So when a young or middle-aged steroid user drops dead, it wasn’t the steroids, it’s claimed to be one of the many other drugs they were taking, or that perhaps they would have died anyway because of bad genetics for heart health, etc.

It’s not completely without basis; again there doesn’t seem to be a big risk of immediate death from taking steroids.

But it’s a distraction, the real concern should be the indirect problems steroid use can lead to through the chronic effect on things like cholesterol ratios and blood pressure. It’s reasonable to assume that such alterations could eventually result in serious pathology.

The problem is we just can’t tell; the list of possible contributing factors in these cases is simply too great to make concrete conclusions.

So where does that leave us?

Nailing down the risk profile of steroids is a quagmire.

It at least seems fair to say the kamikaze approach of bodybuilders who take the most extreme doses is very risky. A complete disregard for health is a great way to make the big-at-any-cost mentality a self-fulfilling prophecy in the grimmest sense. (In my time on bodybuilding discussion forums I found this attitude surprisingly common.)

Epidemiological data might give us a better idea in time, provided we can isolate the variables with some degree of confidence, but people on the lower end of the dosing scale who take time off and keep a close eye on health parameters through regular blood tests seem to be okay.

Perhaps the most useful population to look at is bodybuilders from when steroids were legal and became widely used. Their drug use was narrower in scope, and didn’t include all the other types of drugs used more recently, which means that any patterns we might find are more likely due to the effects of steroids (as non-specific as that is) alone. They don’t seem to be dropping dead drastically early, and it’s generally assumed their steroid intake was on the low end.

But until we have more knowledge of physique-enhancing doses of steroids, the decision to use is a gamble. Of course life itself is full of risk, and everything we do is on a spectrum of cost and benefit, so in the end whether it’s worth it remains dependent on the priorities of any given individual and how much risk they’re prepared to accept in pursuit of their goals.

I think the bottom line is that if you decide to use steroids, you must do it knowing there’s a possibility you might be shortening your life.

Feedback is very welcome, I’d be fascinated to hear your thoughts and about your experiences. Just use the comment form below, or send me an email.

Thank you kindly for reading.

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